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Background New oral anticoagulants hold the promise of simple fixed-dose regimens without the need for monitoring and could make extended use more attractive. Current guidelines advise indefinite therapy in a substantial proportion of DVT patients. The Einstein-DVT study was designed to compare rivaroxaban, a direct oral factor Xa inhibitor, to enoxaparin followed by oral vitamin K antagonist (VKA) treatment in patients with acute DVT for either 3, 6, or 12 months. In Einstein-Extension, patients who had completed 6 to 12 months of anticoagulant treatment for either DVT or PE were randomized to receive rivaroxaban or placebo for an additional 6 or 12 months.

Conclusions Against a background of prolonging anticoagulant treatment for many months to years, this study indicates that oral rivaroxaban, 15 mg twice-daily for 3 weeks followed by 20 mg once-daily, could provide clinicians and patients with a simple, single-drug approach for the acute and continued treatment of DVT that potentially improves the benefit–risk profile of anticoagulation.